public health final draft

pg. 1 September 2013 Jason Jeffery – NI501

Public Health

Jason Jeffery

September 2013

NI501


Health is often not thought of until we are ill (Bury, 2005). Health is a combination of

factors and not only the absence of disease (Marcovitch, 2011). It is also the maintenance and

attainment of mental and bodily health, factors affecting health are things like finance,

environment and education (Marcovitch, 2011). Public health is an area that is targeted

widely to educate people to stay healthy and reduce the risk of illness (GOV.UK, 2015). The

British Government have a variety of different schemes and public health campaigns in place

endeavouring to achieve this goal (Public Health England, 2015). The public health topic I will

be focusing on is smoking. Research suggests that most smokers take up the habit before they

are 18 (Robinson and Bugler, 2008). The highest percentage of smokers are between the ages

of 20 and 34 in men and women (Ash, 2015). Therefore, my main target audience is going to

be unemployed or manual workers between the ages of 16 – 30, this is due to the prevalence

of smokers in these categories (ONS, 2013). This target audience will allow me to educate

people about the dangers of smoking and provide some deterrence and education about the

uptake and continuation of smoking. Providing education can assist a smoker becoming an

expert patient, they are then empowered in discussions with nurses and doctors and are able

to share information with their peers (Prescosolid et al, 2011). Targeting this age range will

also reach out to the biggest problem group due to the highest percentage of smokers in

these age ranges, therefore, increasing the chances of change. The model of change being

referred to will be Prochaska and DiClemente (1984) who use a transtheoretical model of

change, I will also briefly compare this to Lewin’s (1951) model which takes a slightly different

approach to influencing change. Prochaska and DiClemente’s (1984) model will be assessed

to measure its’ potential with regards to stopping smoking. Lastly, a list of useful links and

resources will be suggested to help advocate change and assist in the education of smoking

and its’ associated dangers.

Web Page 1 – Information about the health problem

To the manager:

There are an estimated 1 billion adult smokers worldwide and 9.4 million adult smokers

in the United Kingdom (Cancer Research UK, 2014). These statistics demonstrate that there

is not only a huge proportion of smokers worldwide, but also in the United Kingdom. They are

relevant due to the complications and impacts on health smoking has, not only physiologically

but also psychologically. Smoking tobacco has a negative effect on health, it slowly diminishes


the health of an individual and can result in premature death (Murray, 2014). There are over

7000 chemicals in tobacco smoke, most are toxic with some known to cause cancer (Eriksen,

2012). There are a multitude of health concerns that come with smoking tobacco, some of

these health risks include cancer, coronary heart disease, strokes, peripheral vascular disease,

chronic bronchitis and emphysema (NHS Choices, 2013). With approximately 100,000

smoking related deaths a year in the United Kingdom and approximately 6 million deaths

worldwide per year, it is clear to see that there is a huge health concern that needs to be

addressed (Ash, 2014). The web pages will make the reader fully aware of these issues and

provide them with some factual information about smoking; its detriments and also aids to

quit.

Smoking is highly addictive due to the presence of nicotine in tobacco. Nicotine is a

stimulus for the release of endorphins; a feel good hormone. After a few minutes the effects

of nicotine wear off, withdrawal symptoms can range from irritability or headaches to trouble

sleeping (American Cancer Society, 2015). It is this that drives people to smoke more.

Therefore, I am planning to create an informative web page that will offer information and

statistics about smoking and its concerns. Smoking is an addiction that is present in a range

of socio-economic classifications, over half of unemployed 25 – 34 year olds smoked in 2012

(ONS, 2013). Also, income, education and occupation all have an effect on the uptake of

smoking. People who are in manual occupations have a higher percentage of smokers

compared to people in professional occupations (ONS, 2013). This may be linked to the level

of education and awareness they may have (ONS, 2014). Due to the diverse nature of the

British public, I am aware that my information will need to be available in a variety of forms.

One of my methods to present my information will be via the internet, this will enable a

worldwide audience to access the content. The information will also be available in paper

form at local health centres, schools, colleges, universities and businesses, especially manual

workers due to the higher percentage of smokers. In addition to offering different methods

of communication, I will keep the language user friendly and simple in order to not create a

knowledge gap. It will also be interesting, short and to the point. Addressing these simple

matters will enable me to reach out to my entire target audience from a diverse range of back

grounds, not only those who understand medical language or have a computer. This is

essential to begin to impose change upon individuals.


Smoking is becoming a less prominent habit in Great Britain (Cancer Research UK,

2014). In 1948 approximately 65% of men and 42% of women smoked cigarettes, in contrast,

approximately 24% of men and 18% of women smoke cigarettes in 2012 (Cancer Research

UK, 2014). These webpages will endeavour to continue to educate the population and further

reduce the percentage of smokers. As stated by Cancer Research (Cancer Research UK, 2014)

figures worldwide show a different trend. Low and middle income countries have a rising up

take of smokers, whereas high income countries show a decline in the uptake of smoking

(Cancer Research UK, 2014). It is therefore essential to advocate smoking as a public health

issue and encourage a decline in the percentage of smokers in those countries. Also, targeting

16 year olds may result in more preventable deaths being made (GOV.UK, 2013). Quitting

smoking provides immediate short term benefits and lowers the risk of disease caused by

smoking (Eriksen, 2012).

To the public:

Do you think you know how smoking affects you, your health and your family? There

are approximately 100,000 smoking related deaths a year in the United Kingdom and

approximately 6 million deaths worldwide per year (Ash, 2014).

If your shopping basket included a packet of cigarettes, you could also be putting these

diseases in there too. Think again. There are a multitude of health concerns that come with

smoking tobacco, some of these health risks include:

Cancer; this is a condition that causes cells to reproduce erratically, which can invade

healthy tissues and organs. If not spotted early enough, this can result in death (NHS

Choices, 2013).


Coronary heart disease; this is a build-up of fatty deposits in the coronary artery. The

Coronary supplies blood to your heart. If they become blocked, this can result in a

heart attack or death (NHS Choices, 2013).

(Above. Image taken from: Faressaad, 2011).

Strokes; strokes are life threatening and occur when a blood clot cuts off an area of

your brain’s blood supply. They are also caused by a blood vessel in the brain bursting,

however, smoking could cause a blood clot (NHS Choices, 2013).

Peripheral vascular disease; this is a build-up of fatty deposits in the arteries that limits

blood supply to your leg tissue and muscles. This is dangerous as it can lead onto heart

attack or a stroke (NHS Choices, 2013).

Chronic bronchitis and

emphysema (Chronic Obstructive

Pulmonary Disease; COPD); this is a

condition that causes difficulty

breathing due to narrowing of

airways (NHS Choices, 2013). (Left:

Patient on oxygen due to ill effects

of COPD. Image taken from: GP

Online, 2011).

If you want to change and make a difference, then read on for information on how to

stop. Quitting smoking provides immediate short term benefits such as less breathlessness


and a greater sense of taste and smell. It also lowers the risk of developing the above diseases

(Eriksen, 2012).

Web Page 2 – Plan for behaviour / lifestyle change to help to alleviate the issue

To the manager:

Quitting smoking requires change, I am going to be looking at the available cessation

implementations that are available. Prochaska and DiClemente (1984) use a five stage model.

The first stage is pre contemplation, this is where no thought has been made about change.

In relation to smoking, the individual has not thought about stopping, or they validate a

reason for not stopping. This may be due to pre-existing stress or quitting smoking makes

them put on weight (Ash, 2014). The second stage is contemplation, this is where an individual

will begin to think about quitting smoking. However, change is not imminent as the individual

may be undecided. Persuasion may be necessary to assist the individual in giving up, this could

be health advice, raising awareness of cessation devises or highlighting how much money

could be saved. The third stage is preparation. Preparations made could mean a change of

lifestyle enabling individuals to detach themselves from smoking associated activities, such as

coffee or alcohol (National Cancer Institute, 2010). A particular date may be chosen to quit,

this may involve getting nicotine replacement thera py to help overcome cravings. The fourth

stage is action. A smoker may have decided to stop on a particular day or once their packet

of cigarettes had run out, this would now be putting plans into force. Environmental and

lifestyle changes would have usually occurred to assist action, it may also require support

from the people they regularly come in to contact with. The final stage is known as

maintenance. For a smoker, this would be continuing to strive toward a goal and set small

goals in order to stay focussed and maintain a smoke free life style. There may also be a

requirement for reward. Milestones may be celebrated or the money saved by not smoking

could be saved and given as an achievement (American Cancer Society, 2013). At any stage of

this continuum, there could be some difficulties and this is known as relapse. Not all smokers

are able to stop first time (Ash, 2014). It is a reference to falling back into original behaviours

and starting smoking again, this could happen for a number of reasons. For instance, if the

correct preparations are not made such as not throwing away all cigarettes or living with


someone who smokes in the home, this may result in relapse (NHS Choices, 2014). Individuals

may then come back into the continuum wherever feels relevant, this will depend on the

circumstance and the individual.

Lewin’s (1951) model of change consists of unfreezing, moving and refreezing.

Unfreezing is the process of finding a way to banish adverse lifestyle choices, this is achieved

in three stages. There must be a driving force, restraining forces must be minimalized and

there must be a balance of the driving force and restraining force in order for the unfreezing

stage to work. The next stage of this model is moving, this is where an individual must have a

change of thoughts, feeling or behaviour. The final stage is re-freezing, this is where changes

that have been made are now part of normal activity. Both of these change models could be

an effective way to stop smoking and initiate change. However, in my opinion there is some

fault found within Lewis’s (1951) model in the fact there is no relapse process. It is solely

reliant on the individual keeping themselves motivated and not faltering, there needs to be

options available to individuals that cannot stop in one step (NICE, 2013). For instance, if an

individual falters at the unfreezing stage because they are not prepared, there is no

continuum for them to follow and re-join the process. Whereas, Prochaska and DiClemente

(1984) offer a relapse stage, this allows the individual to re-join wherever they feel suits.

To the public:

Quitting smoking is a difficult task in its self, many of us are fully aware of the health

risks associated with smoking. Are you ready to give up? If you’re reading this, you have

probably made your first steps towards stopping. (Nicorette, 2014)

How can I quit?

Use these five simple steps to start your journey to a healthier life

1. Think about it: Just thinking about stopping is enough to start change. You may still

be undecided whether you want to give up. Think about what you want to gain, how

you might want to do it (Prochaska and DiClemente, 1984).

2. Prepare: How do you want to quit? There are lots of ways you can quit, going cold

turkey, using nicotine replacement therapy (NRT) or hypnosis. Whatever you choose,

make the right preparations. This might mean booking in therapy, stocking up on NRT


products or having no cigarettes in the home or on you (Prochaska and DiClemente,

1984).

3. Action: Actions speak louder than words. Your thoughts and preparations are now put

into place, you would have made some life style changes by this point and possibly

started attending some form of therapy. You should have chosen a date to give up, or

made a pledge to only smoke until your last pack of cigarettes have run out (Prochaska

and DiClemente, 1984).

4. Maintain: Keep focussed. Continue to attend therapy classes and seek support, you

could even set yourself goals to achieve. Why not reward yourself by spending the

saved money towards a holiday or new clothes? (Prochaska and DiClemente, 1984).

Don’t be disheartened if you fall at any step, go back a step or start from the beginning

and continue your journey to change (Prochaska and DiClemente, 1984).

Aids to help with quitting

There are different ways you can quit, with medicine, without medicine or just cold

turkey! Here’s a list of ways that might benefit you:

Nicotine replacement therapy (NRT): this comes in the form of chewing gum, patches,

lozenges, mouth spray, inhalator, electronic cigarettes (E-Cig) (Ash, 2014).

This will help reduce side effects of cutting nicotine out of your lifestyle which include:

Feeling sad or down, having trouble sleeping, feeling irritable or grumpy, having

trouble thinking clearly or concentrating, slower heart rate, gaining weight and feeling

restless (smokefree.gov, 2014).

Stop smoking medicine: Zyban (bupropion) – This medicines effect is not known, but

it is proven to help people to stop smoking (NHS Choices, 2014).

Champix (Varenicline) – This stops nicotine from affecting the parts of your brain that

make smoking feel good (NHS Choices, 2014).

Electronic Cigarettes (E-Cigs) – These devices mimic smoking and produce vapor

(vaping). They deliver nicotine in varying strengths according to your needs. However,

there are no regulations on these products yet meaning the exact ingredients cannot

be guaranteed – even if there is a label. In 2016, there are plans to action this (NHS

Choices, 2014).


Think of the money!

If a packet of cigarettes cost you £5.00 and you smoked five cigarettes a day, you’re

spending £456.25 a year (NHS Choices, 2015). Just think about how many you smoke in a

week and work out the cost for yourself.

Webpage 3 – A useful links page

To the manager:

https://www.gov.uk/government/policies/reducing-smoking

o This provides up to date epidemiology and policies regarding smoking. It also

covers contemporary measures such as electronic cigarettes, I feel this is

extremely useful as most people may have already tried to stop before, and

not been successful. Growth in this area will continue to provide new ideas and

measures to stop for good.

https://www.gov.uk/government/policies/reducing-smoking/activity

o This link is very useful, it is a central home for all the latest and old policies that

members of the public should be aware of. For instance, at the time of writing,

one of the newest additions is a report posted on the decline of the body’s

major systems. This is a brilliant resource for the public, and requires minimal

effort.

http://www.ons.gov.uk/ons/search/index.html?newquery=smoking

o This is an easy to read and accessible resource. There are a variety of studies

that emphasise health risks and epidemiology. Some studies also support

reasons for choosing my target audience.

http://www.nhs.uk/livewell/smoking/Pages/stopsmokingnewhome.aspx

o There are a full complement of additional links within this page that all provide

help and advice on how people can stop smoking. This is essential, variety is

necessary due to different methods working for different people. It is also

accessible due to the language used and the way it is laid out.

http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig

_smoking/





http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/



o This link expands and solidifies the health risks I have presented to the public.

It also references other areas of general life to help the public to understand

the information being presented.

To the public:

Stopping smoking on your own can be difficult, if you want to stop by joining a group

you can find services that are available to you by following this link:

http://www.nhs.uk/Service-Search/Stop-smoking-services/LocationSearch/1846

As you may be aware, smoking has a real detriment on your health. You may have

heard about it in the news or in conversation, here, you can read about how smoking

affects YOUR health, squash any rumours and see the figures for yourself:

http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig

_smoking/

Smoking is expensive. Now you have read how smoking affects your health, work out

how much money you could be spending for a whole host of illnesses and diseases:

http://www.nhs.uk/Tools/Pages/Smoking.aspx

How do other people do it?! Have a look at the journey others have taken, take some

inspiration from them and maybe try them yourself:

http://www.nhs.uk/smokefree/success-stories

Video links, see how other people did it: http://www.nhs.uk/video/pages/chd-

smoking.aspx?searchtype=Search&searchterm=smoking&offset=1&#browse-media-

top

How does smoking affect my life, apart from my health? There are more reasons

other than your health and bank balance to give up smoking. The UK government has

many different policies that limit places you can smoke, how old you have to be to

smoke and you could even be fined for breaking these policies. Even when you go on

holiday, or if you live anywhere else in the world, you may be governed by their

policies:

o Global - http://www.who.int/gho/tobacco/en/

o Global - http://www.who.int/tobacco/mpower/en/

o UK - https://www.gov.uk/government/policies/reducing-smoking/activity

o UK - https://www.gov.uk/smoking-at-work-the-law






http://www.nhs.uk/video/pages/chd-smoking.aspx?searchtype=Search&searchterm=smoking&offset=1&#browse-media-top



http://www.who.int/gho/tobacco/en/

http://www.who.int/tobacco/mpower/en/


https://www.gov.uk/smoking-at-work-the-law


Track your progress. Keep a diary, then you can look back and see how well you have

done. You can do this in a diary, on your computer or using an app:

http://www.nhs.uk/Livewell/smoking/Pages/stopsmokingmobile.aspx



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public health final draft

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